Gastroenterology

Gastroenterology

Volume 99, Issue 5, November 1990, Pages 1401-1407
Gastroenterology

Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage

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Abstract

In a double-blind randomized trial, the hemodynamic events following the administration of propranolol (n = 51) or a placebo (n = 51) were prospectively studied in cirrhotic patients with esophageal varices. The hepatic venous pressure gradient, heart rate, and variceal size were determined at the baseline and 3, 12, and 24 months after the beginning of therapy. Baseline values were similar in both groups. At 3 months, the hepatic venous pressure gradient decreased significantly in propranolol-treated patients (from 18.1 ± 4.2 to 15.7 ± 3.4 mm Hg; P < 0.05) but not in patients receiving the placebo (19.6 ± 6.8 to 17.5 ± 5.3 mm Hg; NS). At subsequent time intervals this gradient decreased significantly from the baseline value in both groups. Heart rate decreased significantly in the propranolol-treated group at all times (P < 0.001). Variceal hemorrhage occurred in 13 patients (11 placebo-, 2 propranolol-treated; P < 0.01), all of whom had a hepatic venous pressure gradient > 12 mm Hg. In 21 patients (14 propranolol-, 7 placebo-treated) the hepatic venous pressure gradient decreased to ≤ 12 mm Hg; none of them bled from esophageal varices, and their mortality rate also decreased. Because most of the bleeding events occurred during the first year (10 placebo-, 1 propranolol-treated; P < 0.01), propranolol seems to have its protective effect during the period associated with the largest reduction in the hepatic venous pressure gradient. Because a reduction in the hepatic venous pressure gradient to <12 mm Hg protects from variceal bleeding and increases the rate of survival, this should be the aim of the pharmacological therapy of portal hypertension.

Abbreviations

AZBF
azygos blood flow
CO
cardiac output
FHVP
free hepatic venous pressure
HR
heart rate
HVPG
hepatic venous pressure gradient
MAP
mean arterial pressure
WHVP
wedged hepatic venous pressure

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This work was supported by the Veterans Administration Merit Review and by Public Health Service Liver Research Grant No. DK 34989.